Wednesday, February 9, 2011

Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Updated

Guidelines for use of ketamine in emergency department (ED) procedural sedation have been updated for the first time since 2004; the use of ketamine has been expanded to include adults and babies between 3 and 12 months of age, according to a new report.

Study Highlights.

Changes since the 2004 guidelines include the following:
  • The updated guidelines now support expansion of ketamine use to children aged 3 to 12 months, which is younger than previously recommended, as well as to adults.
  • Minor oropharyngeal procedures and head trauma are no longer contraindications to ketamine use.
  • Emergency medicine physicians should administer ketamine intravenously instead of intramuscularly whenever feasible because recovery is faster and there is less emesis.
  • Routine use of prophylactic anticholinergic medications is no longer recommended.
  • Routine use of prophylactic benzodiazepines is not recommended for children but may be helpful in adults (eg, midazolam 0.03 mg/kg intravenously; number needed to benefit = 6).
  • Prophylactic use of ondansetron may slightly reduce vomiting (number needed to benefit ≥ 9)
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